Effectiveness of gabapentin as a postoperative analgesic in children undergoing appendectomy
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Though gabapentin is increasingly used as a perioperative analgesic, data regarding effectiveness in children are limited. The purpose of this study was to evaluate gabapentin as a postoperative analgesic in children undergoing appendectomy.
A 12-month retrospective review of children undergoing appendectomy was performed at a two-hospital children’s institution. Patients receiving gabapentin (GP) were matched (1:2) with patients who did not receive gabapentin (NG) based on age, sex and appendicitis severity. Outcome measures included postoperative opioid use, pain scores, and revisits/readmissions.
We matched 29 (33.3%) GP patients with 58 (66.6%) NG patients (n = 87). The GP group required significantly less postoperative opioids than the NG group (0.034 mg morphine equivalents/kg (ME/kg) vs. 0.106 ME/kg, p < 0.01). Groups had similar lengths of time from operation to pain scores ≤ 3 (GP 12.21 vs. NG 17.01 h, p = 0.23). GP and NG had similar rates of revisit to the emergency department (13.8 vs. 10.3%, p = 0.73), readmission (6.9 vs. 1.7%, p = 0.26), and revisits secondary to surgical pain (3.4 vs. 3.4%, p = 1.00).
In this single-center, retrospective cohort study, gabapentin is associated with a reduction in total postoperative opioid use in children with appendicitis. While promising, further prospective validation of clinical effectiveness is needed.
KeywordsGabapentin Appendectomy Abdominal surgery Opioid epidemic Analgesic
Enhanced recovery protocol
Visual analog scale
Length of stay
Morphine equivalents in mg
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to declare. Institutional Review Board approval was obtained prior to chart review and all protected health information was kept strictly confidential. Informed consent was waived given the retrospective nature of the study.
- 3.Edlund MJ, Forman-Hoffman VL, Winder CR, Heller DC, Kroutil LA, Lipari RN, Colpe LJ (2015) Opioid abuse and depression in adolescents: results from the national survey on drug use and health. Drug Alcohol Depend 152:131–138. https://doi.org/10.1016/j.drugalcdep.2015.04.010 CrossRefPubMedGoogle Scholar
- 10.Rusy LM, Hainsworth KR, Nelson TJ, Czarnecki ML, Tassone JC, Thometz JG, Lyon RM, Berens RJ, Weisman SJ (2010) Gabapentin use in pediatric spinal fusion patients: a randomized, double-blind, controlled trial. Anesth Analg 110(5):1393–1398. https://doi.org/10.1213/ANE.0b013e3181d41dc2 CrossRefPubMedGoogle Scholar
- 12.Parikh HG, Dash SK, Upasani CB (2010) Study of the effect of oral gabapentin used as preemptive analgesia to attenuate post-operative pain in patients undergoing abdominal surgery under general anesthesia. Saudi J Anaesth 4(3):137–141. https://doi.org/10.4103/1658-354X.71409 CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Siddiqui NT, Fischer H, Guerina L, Friedman Z (2014) Effect of a preoperative gabapentin on postoperative analgesia in patients with inflammatory bowel disease following major bowel surgery: a randomized, placebo-controlled trial. Pain Pract 14(2):132–139. https://doi.org/10.1111/papr.12058 CrossRefPubMedGoogle Scholar
- 15.Feng C, Anandalwar S, Sidhwa F, Glass C, Karki M, Zurakowski D, Rangel SJ (2016) Beyond perforation: Influence of peritoneal contamination on clinical severity and resource utilization in children with perforated appendicitis. J Pediatr Surg 51(11):1896–1899. https://doi.org/10.1016/j.jpedsurg.2016.08.002 CrossRefPubMedGoogle Scholar
- 16.Kishner S (2018) Opioid equivalents and conversions. MedscapeGoogle Scholar
- 17.Helander EM, Webb MP, Bias M, Whang EE, Kaye AD, Urman RD (2017) A comparison of multimodal analgesic approaches in institutional enhanced recovery after surgery protocols for colorectal surgery: pharmacological agents. J Laparoendosc Adv Surg Tech A 27(9):903–908. https://doi.org/10.1089/lap.2017.0338 CrossRefPubMedGoogle Scholar
- 19.Paul JE, Nantha-Aree M, Buckley N, Shahzad U, Cheng J, Thabane L, Tidy A, DeBeer J, Winemaker M, Wismer D, Punthakee D, Avram V (2015) Randomized controlled trial of gabapentin as an adjunct to perioperative analgesia in total hip arthroplasty patients. Can J Anaesth 62(5):476–484. https://doi.org/10.1007/s12630-014-0310-y CrossRefPubMedGoogle Scholar
- 20.Clarke HA, Katz J, McCartney CJ, Stratford P, Kennedy D, Page MG, Awad IT, Gollish J, Kay J (2014) Perioperative gabapentin reduces 24 h opioid consumption and improves in-hospital rehabilitation but not post-discharge outcomes after total knee arthroplasty with peripheral nerve block. Br J Anaesth 113(5):855–864. https://doi.org/10.1093/bja/aeu202 CrossRefPubMedGoogle Scholar
- 22.Fletcher ND, Andras LM, Lazarus DE, Owen RJ, Geddes BJ, Cao J, Skaggs DL, Oswald TS, Bruce RW Jr (2017) Use of a novel pathway for early discharge was associated with a 48% shorter length of stay after posterior spinal fusion for adolescent idiopathic scoliosis. J Pediatr Orthop 37(2):92–97. https://doi.org/10.1097/BPO.0000000000000601 CrossRefPubMedGoogle Scholar
- 26.Srivastava U, Kumar A, Saxena S, Mishra AR, Saraswat N, Mishra S (2010) Effect of preoperative gabapentin on postoperative pain and tramadol consumption after minilap open cholecystectomy: a randomized double-blind, placebo-controlled trial. Eur J Anaesthesiol 27(4):331–335. https://doi.org/10.1097/EJA.0b013e328334de85 CrossRefPubMedGoogle Scholar